Provider Demographics
NPI:1851803704
Name:HOWARD HOME HEALTH H3 LLC
Entity type:Organization
Organization Name:HOWARD HOME HEALTH H3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:ABID
Authorized Official - Middle Name:
Authorized Official - Last Name:SECIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-452-3039
Mailing Address - Street 1:4604 VARRELMANN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2418
Mailing Address - Country:US
Mailing Address - Phone:314-452-3039
Mailing Address - Fax:
Practice Address - Street 1:4604 VARRELMANN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2418
Practice Address - Country:US
Practice Address - Phone:314-452-3039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1376637251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicaid